JHSC Monthly Workplace Inspection

• Inspection No.

• Conducted on

  Date

Inspection Information

• Facility Inspected

  Select
• GeoTag Location
  Address

• Departments Inspected

  Select

• Areas Inspected:

  Select Area 1 - Packing North Area 2 - Packing South Area 3 - Harvest North Area 4 - Harvest South Area 5 - Tunnels Area 6 - Wharf and Maintenance Other

  • Area 1 - Packing North
  • Area 2 - Packing South
  • Area 3 - Harvest North
  • Area 4 - Harvest South
  • Area 5 - Tunnels
  • Area 6 - Wharf and Maintenance
  • Other

• Please specify inspection area:

• Name of JHSC Member:

• Name of Accompanying Supervisor:

1.0 Previous inspections

• Has the previous workplace inspection sheet been reviewed?

  Yes

  No

  N/A

• Are there any outstanding/not completed items on previous inspection?

  No

  Yes

• List item(s)

2.0 Electrical

• Is the area around electrical panels clear of debris and obstructions? (3 ft in front of the panel and on each side)

  Yes

  No

  N/A
Tap to enter information

• There must be a 3 foot area clear around electrical panels. If a panel is blocked, notify the area supervisor of the issue immediately.

• Is all electrical equipment in good condition? (no frayed or damaged cords, broken outlets?)

  Yes

  No

  N/A

• Immediately inform the area supervisor. DO NOT touch the extension cord if there is evidence of damage or it is not water proofed.

• Are extension cords used only for temporary power needs and water proofed?

  Yes

  No

  N/A

• Immediately inform the area supervisor. DO NOT touch the extension cord if there is evidence of damage or it is not water proofed.

3.0 General Lighting

• Is the area well lit?

  Safe

  At Risk

  N/A

• Lighting is not flickering.

  Safe

  At Risk

  N/A

• Are there any dark areas?

  No

  Yes

• Are any lights burnt out?

  No

  Yes

• Please indicate how many and the location where the lights are burn out

4.0 Housekeeping

• Is the floor clear of loose material, pallets, debris, tools, etc?

  Yes

  No

  N/A

• Are the floors clear of anything slippery, oily or wet?

  Yes

  No

  N/A

• Doors and emergency exits are accessible, (not blocked) and functional

  Yes

  No

  N/A

5.0 Stairways, Hallways & Aisles

• Are there stairways in the inspection area?

  Yes

  No

• Are the stairways well lit?

  Yes

  No

  N/A

• Are the handrails, handholds in place?

  Yes

  No

  N/A

• Are the stairs in good repair?

  Safe

  At Risk

  N/A

• Are stairwells clear and unblocked?

  Yes

  No

  N/A
Tap to enter information

• Are mirrors installed at blind corners?

  Yes

  No

  N/A

• Are traffic mirrors in good condition?

  Yes

  No

  N/A

6.0 Materials Handling & Storage

• Are storage areas free from tripping hazards?

  Yes

  No

  N/A
Tap to enter information

• Do materials interfere with walkways?

  No

  Yes

• Are materials stored neatly and safely?

  Yes

  No

  N/A

• Are there stepladders or stools to get to materials on higher shelves

  Yes

  No

  N/A

• Are heavy and large objects stored on lower shelves?

  Yes

  No

  N/A

7.0 WHMIS/Hazardous Materials

• Are there WHMIS/hazardous materials used in the inspection area?

  Yes

  No
Tap to enter information

• Is there a current SDS sheets (less than 3 years old) for the product(s) available?

  Yes

  No

  N/A
Tap to enter information

• Advise Department Supervisor to update SDS inventory

• Are there secondary containers used?

  Yes

  No

  N/A
Tap to enter information

• Picture of Secondary container

  Media

• Are there Workplace Labels used?

  Yes

  No

  N/A
Tap to enter information

• Are the labels available and up to date?

  Yes

  No

  N/A

• Inform the area supervisor of the missing label(s) and the requirement to label the material.

• Is there an eyewash station or eyewash bottle within 10 feet and free of obstruction?

  Yes

  No

  N/A

8.0 Elevating and Lifting Equipment

• Are there scissor lifts or lifting devices in the inspection area?

  Yes

  No

• Are elevating / lifting devices used only within weight capacity?

  Yes

  No

  N/A
Tap to enter information

• Are capacities posted on the equipment?

  Yes

  No

  N/A
Tap to enter information

• Advise Department Supervisor

• Do associates put on a fall arrest system and attach to an anchor point?

  Safe

  At Risk

  N/A

• Immediately inform the supervisor of the area of the non-compliance

• Are fall arrest systems in good condition and free of corrosion, rips, tears, loose stitching and tell tails?

  Safe

  At Risk

  N/A

• Immediately remove from service if defective and alert the area supervisor

• Are lifting devices inspected yearly and the inspection listed on the device?

  Yes

  No

  N/A
Tap to enter information

• Are the pre-use inspections completed?

  Yes

  No

  N/A
Tap to enter information

• Yearly inspection records must be keep showing; date of inspection, lifting capacity of the device

• Take picture of the inspection sticker

  Media

• Do operators have their current lift ticket on their person?

  Yes

  No

  N/A
Tap to enter information

• Operators must have proof of training in order to operate equipment

• Are chain hoists, ropes and slings marked for load capacity?

  Yes

  No

  N/A

9.0 Warehouse & Shipping

• Is there a shipping dock in your inspection area?

  Yes

  No

• Are dock platforms, bumpers, stairs and steps in good condition?

  Yes

  No

  N/A

• Is there signage for drivers to chock their tires and other safety precautions?

  Yes

  No

  N/A

• Is there racking in the dock area?

  Yes

  No

• Is racking in good condition (no visable damage, missing braces?)

  Yes

  No

  N/A

• Does the racking have a load capacity sticker?

  Yes

  No

  N/A

• Take picture of load capacity sticker on racking

  Media

• Are there contact barriers infront of racking posts to prevent accidental contact?

  Safe

  At Risk

  N/A

• Are there lockout devices and trailer stands available to associates to use?

  Yes

  No

  N/A

• Are trucks locked out or have a trailer stand in place?

  Yes

  No

  N/A

10.0 Safety Environment Items

• Associates who stand for longer than 1 hr at a time have ergonomic mats <br>

  Yes

  No

  N/A

• The area has adequate ventilation/airflow

  Good

  Fair

  Poor

  N/A

• Is there evidence of dust or flammable material build up in the area?

  Good

  Fair

  Poor

  N/A

• Is there any evidence of electrical panels being exposed to water or condensation?

  Safe

  At Risk

  N/A

11.0 AED

• First Aid Stations are indicated with a sign

  Yes

  No

  N/A

• AED Units are indicated with a sign

  Yes

  No

  N/A

• AED Battery reading is, "OK"

  Yes

  No

  N/A

12.0 Security

• Exterior doors are only accessible with a key card/fob

  Yes

  No

  N/A

• Evacuation Points and shelter areas are identified with a sign

  Yes

  No

  N/A

• Lighting is adequate in parking areas and out door walking areas

  Yes

  No

  N/A

• Alarm system functioning (if applicable)

  Yes

  No

  N/A

• Parking Lot lines are painted and applicable signage is present

  Yes

  No

  N/A

13.0 Labels and Safety Items

• Safety labels and warnings are clearly visible and in good condition on applicable items

  Compliant

  Non-Compliant

  N/A

• Equipment and Emergency stations are properly labeled with warning, caution and hazard signs

  Compliant

  Non-Compliant

  N/A

• Seasonal controls (salt, sunglasses, high-vis clothing) are in use

  Yes

  No

  N/A

• LOTO SOP's posted at or near machines

  Yes

  No

  N/A

• What SOPs are missing?

14.0 Noise

• Is it hard to hear in the area?

  Safe

  At Risk

  N/A

• Are associate required to wear ear protection?

  Yes

  No

  N/A

• Are associates wearing hearing protection?

  Yes

  No

  N/A

15.0 Ladders

• Are there ladders or stools in the inspection area?

  Yes

  No

• Stools and ladders in good condition?

  Safe

  At Risk

  N/A

• Ladders do not demonstrate signs of alteration or repairs.

  Safe

  At Risk

  N/A

• The correct ladder type and height is being used for the job task.

  Safe

  At Risk

  N/A

• Feet and braces of ladders are in good condition.

  Safe

  At Risk

  N/A

• There are no loose bolts, no cracks, no splits in frames, excessive rust/corrosion observed.

  Safe

  At Risk

  N/A

• Rails are not twisted or distorted.

  Safe

  At Risk

  N/A

• Steps are not missing, loose or broken.

  Safe

  At Risk

  N/A

16.0 PPE

• PPE is provided to associates

  Yes

  No

  N/A

• PPE is inspected by supervisors

  Yes

  No

  N/A

• PPE stations are properly stocked, in good condition, and prevent unauthorized use.

  Yes

  No

  N/A

• Associates PPE is in good condition

  Yes

  No

  N/A

• Associates are wearing PPE required in the area

  Yes

  No

  N/A

• Inspect an associates shoes at random

  

• Are treads atleast 3mm deep andin good condition?

  Safe

  At Risk

  N/A

• The associate must leave the are until appropriate footwear is worn - alert the department supervisor to the issue

• Is there a distinct heel, sole section of the footwear?

  Safe

  At Risk

  N/A

• The associate must leave the are until appropriate footwear is worn - alert the department supervisor to the issue

• Is there a CSA tag present on the footwear? (exception for harvesters)

  Safe

  At Risk

  N/A

• The associate must leave the are until appropriate footwear is worn - alert the department supervisor to the issue

17.0 Machinery and Guarding

• Are there machines and/or powered tools in the inspection area?

  Yes

  No

• Guards and protective devices are in place and prevent associates from coming in contact with a moving or free wheeling part of a machine.

  Safe

  At Risk

  N/A

• Immediately inform the area supervisor of the issue and inform them of the requirement to stop work until the guard is secure and meets the CSA requirement.

• Labels are present to warn associates of the danger of unsafe actions relating to the equipment

  Yes

  No

  N/A

• Lockout Tagout Maps and SOPs are installed on the machinery.

  Yes

  No

  N/A

• Are pre-work inspections completed for the area?

  Yes

  No

  N/A

• Are controls and e-stops in good working condition?

  Yes

  No

  N/A

• Immediately inform the department supervisor and lock the machine out of service until it can be repaired

• Lockout Stations are properly stocked

  Yes

  No

  N/A

• How many locks are needed to restock?

• How many hasps are needed to restock?

• How many tags are needed to restock?

18.0 Vehicles and Powered Equipment

• Are there vehicles and/or powered devices in the inspection area?

  Yes

  No

• Are pre-use inspection books filled out prior to use?

  Compliant

  Non-Compliant

  N/A

• Do pre-use inspections book contain enough forms for the next 2 weeks?

  Yes

  No

  N/A

• Vehicles do not indicate any form of disrepair

  Safe

  At Risk

  N/A

• Associates are trained and authorized to use equipment they are operating

  Safe

  At Risk

  N/A

• Horns are sounded by operators at doorways, walkways, corners, blind spots, when passing other vehicles or pedestrians?

  Safe

  At Risk

  N/A

19.0 Fire and Building Code

• Doors are clear of obstruction in the inspection area

  Safe

  At Risk

  N/A

• Fire extinguishers are inspected within the last 30 days and have a sign indicating their location

  Compliant

  Non-Compliant

  N/A

• Where is the extinguisher located?

• Emergency exits have panic/push bars installed to allow for quick and safe exit from the building

  Compliant

  Non-Compliant

  N/A

• Which exits are non-compliant?

• Emergency exits are indicated with a sign

  Compliant

  Non-Compliant

  N/A

• Which exit(s) are non-compliant?

• Fire extinguishers are present within 10 feet of hazardous materials, exits and electrical panels

  Safe

  At Risk

  N/A

• Fire evacuation maps are posted through out the facility and at/near exits.

  Safe

  At Risk

  N/A

• Severe weather shelter area sign and/or indicators are clearly labeled and evident in the inspection area

  Safe

  At Risk

  N/A

20.0 Trolley and Rail Use

• Are there harvest trolleys in use in your inspection area?

  Yes

  No

• Trolley welds in good condition (inspect platforms at random)

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

• Trolleys move freely and unhindered

  Yes

  No

  N/A

• Trolley system top and bottom rails in good condition and free of breaks in welds, corrosion, bends, twists, warps, etc.

  Yes

  No

  N/A

• The area must be taken out of service and the supervisor alerted to the issue

• Are there electrical or hand crank operated trolleys in use?

  Yes

  No

• Trolley hand cranks and cables in good working condition

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

• Cable systems are in good condition

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

• Trolleys move freely and unhindered

  Yes

  No

  N/A

• Trolley system top and bottom rails in good condition and free of breaks in welds, corrosion, bends, twists, warps, etc.

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

• Trolley pins in place where required

  Yes

  No

  N/A

• Electric carts are in good condition and show no signs of disrepair

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

• E-stops and controls in good condition and functioning

  Yes

  No

  N/A

• The unit must be taken out of service and the supervisor alerted to the issue

21.0 Violence, Harassment and Bullying

• Associates do not demonstrate impairment mentally, physically or emotionally.

  Safe

  At Risk

  N/A

• Was a supervisor reachable in the area?

  Yes

  No

  N/A

• Associates do not work alone for more then 15 minutes and have a plan in place if working alone is required

  Compliant

  Non-Compliant

  N/A

22.0 Change Management

• Is there any new or modified equipment in the department?

  Yes

  No

• Have there been any recent changes to the processes? i.e. equipment moved or relocated?

  Yes

  No

  N/A

• Was the JHSC involved at the onset of the process change or procuring the equipment?

  Yes

  No

  N/A

• Was a Pre-start completed with the JHSC prior to it being released to production?

  Yes

  No

  N/A

23.0 Contractor Safety Compliance

• Are there any contractor(s) in the department performing work?

  Yes

  No

• Has the contractor(s) signed in at the front office?

  Yes

  No

  N/A

• Has the contractor(s) completed the Highline COVID19 Screening in at the front office?

  Yes

  No

  N/A

• Has the contractor(s) completed contactor safety training prior to performing work?

  Yes

  No

  N/A

24. New and Young Associates

• Are there any new or young (Age 16-24) associates in the inspection area?

  Yes

  No

• Have you introduced yourself to the new/young associate?

  Yes

  No

  N/A

• Please ensure to introduce yourself to any new/ young workers in the inspection area.

• Name of Associate Communicated with:

  Sign

• Is there a Safety and Wellness Information board in your inspection area?

  Yes

  No

• Highline Mushrooms Safety and Wellness Policy current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Employment Standards Information present and in good condition

  Compliant

  Non-Compliant

  N/A

• Worker Rights Information present and in good condition

  Compliant

  Non-Compliant

  N/A

• Workers compensation (1,2,3,4, WBC, WorkSafe Injury) Poster present and in good condition

  Compliant

  Non-Compliant

  N/A

• Highline Mushrooms Violence, Bullying and Harassment policy and standard current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• JHSC Meeting Minutes current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• JHSC Member Photos and Contact information current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Health and Safety at Work poster present and in good condition

  Compliant

  Non-Compliant

  N/A

• Ministry of Labour field reports, orders, tickets and fines current, present and in good condition (if applicable)

  Compliant

  Non-Compliant

  N/A

• Injury Reporting and Disability and Claims poster current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• List of first aiders present?

  Compliant

  Non-Compliant

  N/A

• Emergency Contact Numbers current, present and in good condition?

  Compliant

  Non-Compliant

  N/A

• A copy of the OH&S Act is current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• A safety and wellness policy and information binder is current, present and in good condition

  Compliant

  Non-Compliant

  N/A

• Important information - Hazards, substances, safety alerts, etc. (if applicable)

  Compliant

  Non-Compliant

  N/A

• At random, ask an associate if they can be interviewed for a quick safety questionnaire

• Where do you go in the event of an emergency (fire, tornado, violence)?

• Where is the first aid station located?

• What do you do if you are involved in an incident (injury, property damage, near miss) in the workplace?

• Is PPE readily available for you to complete your job tasks?

  Yes

  No

  N/A

• Do you feel you are properly trained to conduct your work duties?

  Yes

  No

  N/A

• Why do you feel you have not adequately been trained?

• Do you have any suggestions for making your working environment safer?

  Yes

  No

• Comments

• Surveyed Associates Name and Signature

  Sign

• Hazards observed during inspection - One (1) Risk Assessment is Required per inspection.
  Class A - Condition or practice with potential for a Critical Injury or Death
  Class B - Condition or Process with potential for serious injury or property damage Class C - conditions or practices with potential for minor injury or property damage

Hazard observed

• Use this tool to determine the Risk level rating

  

RECOGNIZE

HAZARD

• What activity or hazard could cause injury or illness?

• What hazard groups can cause injury, illness, property damage or damage to the environment? (select all that apply)

  Select Physical Safety MSD Chemical Physical Agent Psychosocial Biological Manual Material Handeling

  • Physical Safety
  • MSD
  • Chemical
  • Physical Agent
  • Psychosocial
  • Biological
  • Manual Material Handeling

• What is the source of the hazard to the associate/environment?

  Select Compressed Air High Pressure Fluids Confined Space Driving Electrical Material Handling Material Storage Molten Material Machine or Equipment Slip or Trip Temperature Vehicular Hazards Working at Heights

  • Compressed Air
  • High Pressure Fluids
  • Confined Space
  • Driving
  • Electrical
  • Material Handling
  • Material Storage
  • Molten Material
  • Machine or Equipment
  • Slip or Trip
  • Temperature
  • Vehicular Hazards
  • Working at Heights

• What is the potential outcome of exposure to the hazard?

  Select Skin injection Skin injection Asphyxiation Engulfment Entrapment Explosion Collision Contact with pedestrian Other Stress Violence Arc flash Electrocution Fire hazard Crushing Fire hazard Laceration Puncture or injection Sharp edges - laceration/contusion Struck by Worker contact Fire hazard Trip hazard Worker contact Burn Fire Flying particles/materials - impact or injection Full body pinch point - crushing Grinding/Sanding - friction & abrasion Impact - stabbing & puncture In-running nip - entanglement, drawing in Moving part - entanglement, cutting, shear Pinch point - crushing or shear Rotating or sharp part - cutting or shearing Rotation - entanglement Sharp edges - laceration/contusion Worker contact – laceration/contusion/puncture/other Falls to same height Burn/Scald Falling to surface below Objects falling on workers below Other

  • Skin injection
  • Skin injection
  • Asphyxiation
  • Engulfment
  • Entrapment
  • Explosion
  • Collision
  • Contact with pedestrian
  • Other
  • Stress
  • Violence
  • Arc flash
  • Electrocution
  • Fire hazard
  • Crushing
  • Fire hazard
  • Laceration
  • Puncture or injection
  • Sharp edges - laceration/contusion
  • Struck by
  • Worker contact
  • Fire hazard
  • Trip hazard
  • Worker contact
  • Burn
  • Fire
  • Flying particles/materials - impact or injection
  • Full body pinch point - crushing
  • Grinding/Sanding - friction & abrasion
  • Impact - stabbing & puncture
  • In-running nip - entanglement, drawing in
  • Moving part - entanglement, cutting, shear
  • Pinch point - crushing or shear
  • Rotating or sharp part - cutting or shearing
  • Rotation - entanglement
  • Sharp edges - laceration/contusion
  • Worker contact – laceration/contusion/puncture/other
  • Falls to same height
  • Burn/Scald
  • Falling to surface below
  • Objects falling on workers below
  • Other

• What is the source of the hazard to the associate/environment?

  Select Awkward Posture High Force Demands Poor Tool or Equipment Design Poor Workstation Design Repetition Static Posture

  • Awkward Posture
  • High Force Demands
  • Poor Tool or Equipment Design
  • Poor Workstation Design
  • Repetition
  • Static Posture

• What is the potential outcome of exposure to the hazard?

  Select MSD injury Other

  • MSD injury
  • Other

• What is the source of the hazard to the associate/environment?

  Select Combustible Compressed Gas Corrosive Flammable Reactivity Toxic

  • Combustible
  • Compressed Gas
  • Corrosive
  • Flammable
  • Reactivity
  • Toxic

• What is the potential outcome of exposure to the hazard?

  Select Fire/Explosion Violent release of energy/gas Acid - skin burn/mucous membrane exposure Acid/base incompatibility reaction Alkaline - skin burn/mucous membrane exposure Liquid - Fire/explosion Gas - Fire/explosion Dangerous reaction Absorption - Illness Dermatitis Ingestion – Illness Ingestion – Carcinogen Inhalation – Illness Inhalation - Carcinogen Injection – Illness Injection - Carcinogen

  • Fire/Explosion
  • Violent release of energy/gas
  • Acid - skin burn/mucous membrane exposure
  • Acid/base incompatibility reaction
  • Alkaline - skin burn/mucous membrane exposure
  • Liquid - Fire/explosion
  • Gas - Fire/explosion
  • Dangerous reaction
  • Absorption - Illness
  • Dermatitis
  • Ingestion – Illness
  • Ingestion – Carcinogen
  • Inhalation – Illness
  • Inhalation - Carcinogen
  • Injection – Illness
  • Injection - Carcinogen

• If Hazardous materials are present, are there SDS sheets available to associates at all times and are associates trained in WHMIS 2015?

  Compliant

  Non-Compliant

  N/A

• What SDS sheet or training is required?

  Yes

  No

  N/A

• What is the source of the hazard to the associate/environment?

  Select Extreme Cold Extreme Heat Lighting Noise UV Exposure Vibration

  • Extreme Cold
  • Extreme Heat
  • Lighting
  • Noise
  • UV Exposure
  • Vibration

• What is the potential outcome of exposure to the hazard?

  Select Cold stress Heat stress Hazard exposure due to lack of visibility Eye strain Hearing loss Skin or eye damage Hand/Arm - MSD or vascular disorder Whole body - Back pain

  • Cold stress
  • Heat stress
  • Hazard exposure due to lack of visibility
  • Eye strain
  • Hearing loss
  • Skin or eye damage
  • Hand/Arm - MSD or vascular disorder
  • Whole body - Back pain

• What is the source of the hazard to the associate/environment?

  Select Boredom Harassment Stress Violence Work overload Long hours

  • Boredom
  • Harassment
  • Stress
  • Violence
  • Work overload
  • Long hours

• What is the potential outcome of exposure to the hazard?

  Select Mental Illness Violent Situation Physical Health Decline

  • Mental Illness
  • Violent Situation
  • Physical Health Decline

• What is the source of the hazard to the associate/environment?

  Select Bacteria Mold Viral

  • Bacteria
  • Mold
  • Viral

• What is the potential outcome of exposure to the hazard?

  Illness/Disease

• What is the source of the hazard to the associate/environment?

  Select Bending Lifting Pushing or Pulling

  • Bending
  • Lifting
  • Pushing or Pulling

• What is the potential outcome of exposure to the hazard?

  Strain

• Hazard Images and DIagrams

  Media

• Additional Comments

ASSES

Assessment

• What is the probability of an incident occurring?

  Almost Impossible - 1

  Not Likely - 2

  50/50 - 3

  Very Possible - 4

  Almost Certain - 5

• How often is the job task interacting with the hazard?

  Yearly - 1

  Monthly - 2

  Weekly - 3

  Daily - 4

  Continuously - 5

• How severe could an incident be?

  Select 1 - Negligible/First Aid 2 - Minor/Marginal 3 - Critical/Medical Attention 4 - Catastrophic/Lost Time 5 - Fatality/Total System Failure

  • 1 - Negligible/First Aid
  • 2 - Minor/Marginal
  • 3 - Critical/Medical Attention
  • 4 - Catastrophic/Lost Time
  • 5 - Fatality/Total System Failure

• What is the risk level?

  Select Class C (1-2): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class B (2-3): A condition or practice that is likely to cause serious injury or illness resulting in temporary disability (medical aid) Class A (4-5): A condition or practice that is likely to cause permanent disability, loss of life or body part - Immediate action must be taken

  • Class C (1-2): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class B (2-3): A condition or practice that is likely to cause serious injury or illness resulting in temporary disability (medical aid)
  • Class A (4-5): A condition or practice that is likely to cause permanent disability, loss of life or body part - Immediate action must be taken

• If immediate action is required; issue a work order from the app to the Maintenance Manager of the location.

• What is being done immediately to prevent an incident?

• What is the Risk Priotrity?

  Low

  Medium

  High

  ASAP/Immediate

• Additional Comments:

CONTROLS AND RECCOMENTDATIONS

• Use this tool when considering control implementation and recommendations.

  
Control and Recommendation

• What legal requirements, codes, benchmarks or standards apply to the identified hazards, work processes or work activities?

  Select OHSA CSA Electrical Fire/Building Other

  • OHSA
  • CSA
  • Electrical
  • Fire/Building
  • Other

• What legal requirement is in non-coompliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Are controls immediately put into place or recommended introducing a new hazard? (congestion, confined space, etc.)

  Safe

  At Risk

  N/A

• Describe in detail what the new hazard identified is:

• Will new training be required for the new controls put into place?

  Yes

  No

  N/A

• What training will be required?

• Are any labels, signs or decals required if controls are put in place?

  Yes

  No

  N/A

• What labels, signs or decals are required?

• Is additional PPE required?

  Safe

  At Risk

  N/A

• What PPE is required?

• Is a Safety Alert required or alteration to a hazard checklist?

  Yes

  No

  N/A

• What action is required?

• What CSA Standard is in non-compliance?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What electrical code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• What fire/building code item is non-compliant?

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Describe the non-compliance

  Yes

  No

  N/A

• What is currently being done to eliminate or control the hazard?

• RECCOMENDED ACTION - What future actions are needed to eliminate or control hazards? Indicate recommendations here - include diagrams and photos if necessary.

• Who is responsible for overseeing the change?

• Recommended timeline of completion:

  Date

• Additional Comments:

EVALUATE

Evaluation

• Following recommended control implementation, how likely is the hazard to cause injury or illness now?

  Almost Impossible - 1

  Not Likely - 2

  50/50 - 3

  Very Possible - 4

  Almost Certain - 5

• Following recommended control implementation, how often is the job task interacting with the hazard?

  Yearly - 1

  Monthly - 2

  Weekly - 3

  Daily - 4

  Continuously - 5

• Following recommended control implementation, how severe could an incident be?

  Select 1 - Negligible/First Aid 2 - Minor/Marginal 3 - Critical/Medical Attention 4 - Catastrophic/Lost Time 5 - Fatality/Total System Failure

  • 1 - Negligible/First Aid
  • 2 - Minor/Marginal
  • 3 - Critical/Medical Attention
  • 4 - Catastrophic/Lost Time
  • 5 - Fatality/Total System Failure

• Following recommended control implementation, what is the level of risk?

  Select Class C (1-2): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage) Class B (2-3): A condition or practice that is likely to cause serious injury or illness resulting in temporary disability (medical aid) Class A (4-5): A condition or practice that is likely to cause permanent disability, loss of life or body part - Immediate action must be taken

  • Class C (1-2): A condition or practice that is likely to result in minor non disabling injury or illness (first aid, property damage)
  • Class B (2-3): A condition or practice that is likely to cause serious injury or illness resulting in temporary disability (medical aid)
  • Class A (4-5): A condition or practice that is likely to cause permanent disability, loss of life or body part - Immediate action must be taken

• Additional Comments:

• Only complete this page if you have been designated to inspect the first aid room. If you have not been selected to inspect the first aid room, please continue to the next page.

• Is there a First Aid Room in your Inspection Area which you are required to inspect?

  Yes

  No

• First Aid Stations are indicated with a sign

  Yes

  No

  N/A

• 1 Dressing Scissors (2)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 2 Dressing Forceps (Tweezers) (2)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 3 Safety Pins (24)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 4 Cotton-Tipped Applicators (Q-tips)(50)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 5 Antiseptic Wipes(24)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 6 Adhesive dressings individually wrapped (bandaids)(60)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 7 2" Sterile Gauze Pads (48)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 8 3" Sterile Gauze Pads (48)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 9 1" Gauze Bandages (12)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 10 2" Gauze Bandages (8)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 11 4" Gauze Bandages (4)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 12 Absorbent Cotton - Cotton Balls (25)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 13 Triangular Bandages (12)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 14 Splints of assorted sizes

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 15 Splint padding (2)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 16 Hot and cold running water

  Yes

  No

  N/A

• 17 Stainless steel washbasins (3)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 18 Cabinet for storing the dressings (1)

  Yes

  No

  N/A

• 19 Garbage receptacle with lid (1)

  Yes

  No

  N/A

• 20 Couch or bed to lie on (1)

  Yes

  No

  N/A

• 21 Stretcher (1)

  Yes

  No

  N/A

• 22 Blankets (2)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 23 CPR Mask (1)

  Yes

  No

  N/A

• 24 Non-Latex Gloves - Size Small (2 pairs)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 25 Non-Latex Gloves - Size Medium (2 pairs)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 26 Non-Latex Gloves - Size Large (2 pairs)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 27 Valid Standard St. John Ambulance Manual

  Yes

  No

  N/A

• 28 Burn Gel (10)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 29 Splinter Remover (5)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 30 After Bite (10)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• 31 Ice Packs (10)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• Is there a first aid station in your area that you are required to inspect?

  Yes

  No

  N/A

• Safety Pins (24)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Adhesive Dressings - Sterile (24)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• 3" Sterile Gauze Pads (12)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Rolls of 2" Gauze Bandages (4)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Rolls of 4" Gauze Bandages (4)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Triangular Bandages (6)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Roll Up Splint

  Compliant

  Non-Compliant

  N/A

• Splint Padding (2)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Sterile Surgical Pads for Pressure Dressings (4)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• CPR Mask (1)

  Compliant

  Non-Compliant

  N/A

• Roll of Adhesive Medical Tape (1)

  Yes

  No

  N/A

• Antiseptic Wipes (24)

  Yes

  No

  N/A

• How many items are needed to re-stock the station?

• Non-Latex Gloves - Size Small (2 pairs)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Non-Latex Gloves - Size Medium (2 pairs)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Non-Latex Gloves - Size Large (2 pairs)

  Compliant

  Non-Compliant

  N/A

• How many items are needed to re-stock the station?

• Valid FIRST AID/CPR Manual

  Compliant

  Non-Compliant

  N/A

• First Aid Reg 1101

  Compliant

  Non-Compliant

  N/A

• Ice Pack (1)

  Compliant

  Non-Compliant

  N/A

• Burn Gel (1)

  Compliant

  Non-Compliant

  N/A

• Compliant

  Non-Compliant

  N/A

• Comments:

• JHSC Rep Name and Signature

  Sign

• Supervisor or Manager Name and Signature

  Sign